MEDICARE: MRS. NOMPELELO KHUMALO BOUCHER LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MHC00708	RI
2	101YM0800X	Mental Health Counselor	9201	MA

General Provider Information

NPI Number	:	1629128012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NOMPELELO KHUMALO BOUCHER LMHC

Provider Business Mailing Address
First Line	:	9 RUSTIC LN
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-1141
Country	:	US
Telephone Number	:	617-791-2645
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 NATE WHIPPLE HWY STE 202
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-1423
Country	:	US
Telephone Number	:	401-405-0700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	01/12/2025

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